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Miscellaneous - 332 RALEIGH TAVERN LANE 4/30/2018 (2)
E-' r a m North Andov�,,r Board of Assessors Public Access Page 1 of 1 NORTH I!l�rfh Andover Beard of Assessors roperty Record Card Parcel ID :210/107.A-0130-0000.0 FY:2012 Community: North Andover Click on Sketch to Enlarge Click on Photo to Enlarge Location: 332 RALEIGH TAVERN LANE Owner Name: ANDERSON, DAVID V LINDA J ANDERSON Owner Address: 332 RALEIGH TAVERN LANE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7 - 7 Land Area: 1.06 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1962 sqft Value: 447,500 447,500 ing Value: 221,400 221,400 Value: 226,100 226,100 Market Land Value 226,100 Chanter Land Value: Price: 0 Sale Date: 01/01/1974 s Length Sale Code: N -NO -OTHER Grantor: Doc: Book: 01246 Page: 0387 http://csc-ma.us/PROPAPP/display.do?linkld=1896120&town=NandoverPubAcc 1/19/2012 North Andover Board of Assessors Public Access Page 1 of 1 NORTH I��rEh Andover Board of Assess®rs 3? a .�. ..... • pt _ e _ - - MATCHING PARCELS Click on a column title to sort data by that column 66 items found, displaying 51 to 66. [First/Prev] 1 1 2 [Next/Last] Fiscal Year I Parcel ID ( St.No. Street Owner Name 2012 210/106.0-0112-0000.0 296 LEIGH MC QUAID, DANIEL M, CAROL M MC TAVERN LANE QUAID 2012 1210/107.A-0128-0000.0 300 LEIGH RAMANI, ARVIND, TAVERN LANE 2012 210/107.A-0127-0000.0 301 LEIGH MAHONEY, RAYMOND J, CHARLINE T TAVERN LANE MAHONEY 2012 210/107.A-0129-0000.0 316 LEIGH COLTIN, RONN L, KATHY L COLTIN TAVERN LANE RALEIGH 2012 ;210/107.A-0126-0000.0 317 TAVERN LANE CAMPION, MICHAEL, 2012 1210/107.A-0130-0000.0 332 LEIGH ANDERSON, DAVID V, LINDA J TAVERN LANE ANDERSON 2012 333 LEIGH ZOLL, JENNIFER, ZOLL, OTTO 1210/107.A-0125-0000.0 TAVERN LANE 2012 1210/107.A-0131-0000.0 344 LEIGH CALLAHAN, MICHAEL, J., CALLAHAN, TAVERN LANE DANIELLE, C. 2012 210/107.A-0124-0000.0 345 LEIGH LANE, SCOTT P., LANE, MARCIA TAVERN LANE p 2012 1210/107.A-0132-0000.0 356 RALEIGH DISTEFANO, THOMAS J, DONNA M TAVERN LANE DISTEFANO r 2012 _ 357 - LEIGH TAVERN CRONIN, CHERYL L, 1210/107.A-0123-0000.0 LANE 2012 210/107.A-0122-0000.0 373 IRALEIGH FRANGULES, ARIST P, KAREN D TAVERN LANE ---r ---- 2012210/107.A-0134-0000.0 384 _ ---- LEIGH -FRANGULES ------------- OLD NORTH ANDOVER REALTY TRUST, TAVERN LANE C/O BEN OSGOOD 2012 1210l107.A-0121-0000.0 385 RALEIGH LYNCH, ROBERT W, VIETZKE-LYNCH, TAVERN LANE HOLLY M 2012 210/107.A-0094-0000.0 416 LEIGH SCHMITT, ARTHUR L, TAVERN LANE 2012210/]07.A-0095-0000.0 417 LEIGH ZOLOTYKH, VALERIY, TATYANA TAVERN LANE ZOLOTYKH 66 items found, diSUlavinp- 51 to 66. [First/Prevl 1 1 2 [Next/Last] http://csc-ma.us/PROPAPP/newSearch.do?noOwner--027%3BO84%3BO59%3BO04%3B 1... 1/19/2012 t OF �.10RT/i-gti COPY SSA C HUs PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division Certificate of Compliance As of.• Xa 9, 2012 This is to cert ify that a SA`IISTACIORT IMPECITO5V Was completed for the: Tuff &pair of an On Site Wastewater AwosaCSystem Oy: Todd (Bateson at: 332 &k!0 Tavern Gane Parcel ID :210/107.A-0130-0000.0 9VorthAndover, MA 01845 The Issuance of this certificate shad not be construed as a guarantee that the On -Site Sewage (DisposaCSystem wiCCfunction satisfactorily. T Sawye� Yfeafth Di 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ,tORTh •� OL 1P t � �[y,+yy 1 TOWN OF NORTH ANDOVER PUBLIC HEALTH DEPARTMENT HEALTH Df-PARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed; ( ) repaired; By: "Fe h Z&5��D h� (Print Name) II ff / Located at:I'2_7j ,I.L Ira N e 2 1A , (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated ��^l ,�I and last revised on , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: 1— I q— I L, L� I,/U Q'C4' z And — Print Name Final Construction Inspection Date: A ILLI And — Print Name Installer: (Signature) Enginer• �I r�Otiull� ���X(�C/pk (Signature) Engineer Representat ve (Signature) t /- Engineer Represents ve (Signature) Date: And — Print Name Date: O� -O Y- /2 - VZ 401401 Nih(4k�ltkt, And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web http://www.townofnorthandover.com L_�' AS -BUILT CHECKLIST All changes to the design plan have been reflected on the as -built Is of suitable scale; (one inch = 40 feet or fewer for plot plans and one inch = 20 or fewer for details of system components) Lot number, Streetml�a e, Assessors Map and Parcel Number Lot Lines and Location of Dwellings served by the system Locations & Dimensions of system, including reserve (if applicable) Ties to dwelling or Permanent Structure & Wells a. From Septic Tank b. From Leach Area Ties to Lot Lines from leach area Locations of Deep Holes & Peres Elevations of Disposal System Top of Foundation Elevation Locations of Wells, Drains, Watercourses within 150 feet of system Location of water, gas, electric lines, cable Distances from Corners of House to Center of Tank & D -Box Location of Structures within 6 Inches of Finished Grade Original Stamp & Signature Location and holder of any easements which could impact the system Impervious Areas; Driveways, etc North Arrow Location & Elevations of Benchmark used STATEMENT ON PLAN (NA 5.3) MAY � 9 TOWN OF NORTH ANDOVER HEALTH QEPARTMENT "I certify the locations, elevations, ties, cover material; exposed component covers etc. shown on this as -built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met. " Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT (NA 4.9) Letter or statement on the as -built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of: Wednesday, April 27, 2011 Grant, Michele From: Sawyer, Susan Sent: Thursday, April 12, 201212:57 PM To: Grant, Michele; DelleChiaie, Pamela Subject: 332 RTL Bill Dufresne called, He was at 332 Raleigh Tavern Lane. The plan had an error on the house which resulted in 4 feet less to the field. There was a jo in the house h missed. T e new distance is 30 feet from the corner. I am sure they will be calling for a Bottom of Bed soon. Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg. 20, Unit 2-36 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email ssawyerCcDtownofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. A + II r y. ak yam' i� i �•)�1'`i,F1pL• AI.,►�ai .i I t '!'y�.1. r � g7 ,^„Aw �fW,.4.�"`r � Av Yr �• %`t�'Gj �J pel. - �jf � /� � tt�t iF-1 '�� � �. ��'� ..+ F ''��Sjat+4' � A11`a r a� j•�. r � '" j , r { `- - , r9iF s t♦ Ar ��''1. +!'^� }} A w°�'+f"`" . 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VIA 4, yea �rr{( T,r� s s i t 1 M ,j,4A) { t ++ JA f i a ii a f� i w - ,� ��''�.„". moi. # •�• Ao a j a r F " y �y, �• i t :'cif .t tJ'��.-, •�f� i' ,�, c + +" A y� i a VVV r. + R n N M,7 : �F f.V KW log H/*.■ ili...w;. S 11i �q k ,y b li 4. � �.� , r�.. jp as �i t i / + 1 i K F XfINITY Connect photo.7PG :Ru•I.seOwo:)@TTT!aq 898p 1=plLsaSEunmain/q/tau•tsuauioa•l!uaranvt i OOzS//: dpq http://sz0014.wc.mail.comcast.net/h/viewimages?id=14$42 beilll@comcast.net 9d['oloyd :P9uuo3 AIINIAX vq21T"i 1 photo.JPG (JPEG Image, 320 x 240 pixels) lofl http://sz0014.wc.mail.comcast.net/service/home/—/photo.JPG?auth=c... 4/19/2012 7:53 PM Ir North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 332 Raleigh Tavern Lane MAP: 107A LOT: 130 INSTALLER: Todd Bateson DESIGNER: Vladimir Nemchenok PLAN DATE: 12/21/11 BOH APPROVAL DATE ON PLAN: 2/29/12 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 4/18/12 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK ® Contractor reports any changes to design plan — bump out in basement not shown on plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered ❑ Building sewer in continuous grade, on compacted firm base Cleanouts per plan Bottom of tank hole has 6" stone base ❑ W e hole plugged ❑ gallon tank has been installed 4 dv loading Monolithic tank construction Water tightness of tank has been achieved by testing a ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port Hydraulic cement around inlet & outlet Comments: Not installed, will be installed after backfilling over SAS DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: Need to hydraulic cement around inlet/outlets and add inlet tee. SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ® Retaining wall (concrete) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 9 ® Number of rows (trenches): 5 Comments: Total Chambers = 45 BM = 100.00 H R = 4.26 HI = 104.26 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark 4.26 Building Sewer OUT Septic Tank IN Septic Tank OUT Distribution Box IN 15.76 88.15 88.10 Distribution Box OUT 15.93 87.98 87.93 Lateral 1 TOP 16.02 Lateral 1 INVERT 87.89 87.87 Lateral 2 TOP 16.00 Lateral 2 INVERT 87.91 87.87 Lateral 3 TOP 16.04 Lateral 3 INVERT 87.87 87.87 Lateral 4 TOP 16.05 Lateral 4 INVERT 87.86 87.87 Lateral 5 TOP 16.04 Lateral 5 INVERT 87.87 87.87 Top of Chamber 16.04 88.22 88.20 Bottom of Bed/Chamber 87.22 87.20 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 (70' as proposed) ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Commonwealth of Massachusetts Map -Block -Lot 107.A0130 -------------------- BOARD OF HEALTH Permit No 44 -20 North Andover BHP -2012-0544 544 01 FEE F.I. DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd -Bateson to (Repair) an Individual Sewage Disposal System. N 332 RALEIGH TAVERN LANE $250.00 ------------ ato — — ----------------------------------------------- as shown on the application for Disposal Works Construction Permit No. 13HP-2012-054 Dated --March-3-0,-2-0-1-2 -_-- Issued On: Mar -30-2012 BOARD OF HEALTH 1 TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component Important: Aaniication is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use Nepak or replace an existing on-site sewage disposal system` only the tab key to move your ❑ Repair or replace an existing system component— What? cursor- do not use the return A. Facility Information key. -33) V JV, sn rt c Addressor Lot # I rwFEeE10 fy I M ICS 6 �P_uymPpE00FGSmvlty EPTIC SYSTEM*: TOWN OF NORTH ANDOVER HEALTH DEPARTMENT (choose one) ***If pump system, attach copy of electrical permit to application*** n❑ onventional System (pipe and stone system) Infiltrator or Blodiffuser (gavel -Less) (Attach a copy of your certification to install this type of system. ❑pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name 7 Address ('d different from above) City/Town State 0� ��p Code / 8-te Telephone Number 3. Installer Information �% -� Sdi✓ 13AIMON ENTERPRIRP-q ImA, NameName of Co any 111 ARGILLA ROAD U'.9- � ' ANDOVER, MA olala P ddress Cityfrown State Zip Code Telephone Number (Cell Phone # if poulble please) 4. Designer Information Name J Name of Company T Address I n Eilyfrown State . Zip Code Telephone Number (Fest#to Reach) Application for Disposal System Construction Permit • Page 1 of 2 h. M°RTM Application..for Septic Disposal; System �� �Y'S DATE p Construction-Permit—'TOWN. OF TODAY'S $.250.00 -Full Repair ORTH ANDOVERMA 01845 5 $$225.0 - Component S � PAGE 2OF2 A. Fadility.lnformatio.n continued.... 5. Type, of Building: gResidential Dwelling or ❑commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the been issued this Board of Health. system in operation until a Certificate of Compliance has Name Date Application Ap By: (Board of Health Representative) Nam e Date Application Disapp/,oved., `or the following reasons: For Office Use Only: 1 Fee Attached. Yes 2. ProjectMariager Obligation Form Attached? Yis 3.: 1'um , stem? rfsol Attach copv ofElectrical Permit` _ Yes 4. Foundation As Built.? (new construction -ronly): Yes_ (Same scale as approved plan) 5. FloorPlans? (new construction only); Yes No No No No No Application tor•pisposai; ysterii.conttraction Permit *Page 2 of 2 9 .� SEPTIC SYSTEM. INSTALLER PROJECT MANAGEMENT OBLIGATIONS for the constructioti for°the septic systern for the property .at: As the North Andover -licensed installer (Ad(Uess of septic system) (� Relative to the application of (in'staller's name) For plans by (Engineer) And dated A) — A /— / 1 ngina date). Dated-�-� i �- With revisions dated 1 � �3 o a s ate.)(Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am .obligated to obtain all permits and Board ofHealth approved plans prior to ;performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer,.I.must call for any and all inspections: If homeowner, contractor, project manager, or any other person not associated with my company schedules -an inspection and the system is not ready, then item three- shall - be. applicable. 3. As the installer, I am required to, have .the necessary work completed prior :to the applicable inspections as indicated below:. I understand that reg ,uestin� inspection, without comlilefion: of the items in. accordanc _. -I A _ �•__•�a ::x�e-t,�`60r.fine bein�.levied a,amst:me_and/oj a: Bo'tfom of Bed Generally, this -is the `first.(1' inspection unless: there is a retaining wall, which should be done< rst. T-he`installer must request die in but sloes not have to be present. b. Final-Cdnstr1,cd6h IA§Petition — Engineer must:firsi.do their- inspection for elevations; ties, etc. As -built of verbal OK (or a -mail to: healtlde�it�townofriorthandover.com): from the engineer must be submitted to.the.Board of Health, after.�vhich:installer.cails for;ari inspection tirue. Installer must be present for this inspection. With a pump system, all electrical work m' ust be ready annd able to cause pump to work arid: alarm xo, function.. c. FinAGt'_ade —.Install& must request inspection when ill.grading is complete. Installer does not have to be -on=site. 4. As -the installer,I understand that only I paay perform the work (other rim,ple excavation) and I am required to complete the installation of the system identified in .the: attached application: for installation: 'I further .understand that work done � others unlicensed to install septic systems in North Andover can consttate reasons for denial of the.system and /or,revocation or suspension of.my lieense:to operate in. the Tovvn.of `l d` l•bl North Andover siOn, t fines to all persons-invo ve are a so posse e. 5.. ,As the.installerJ understand that J must be onsite during the performance .of the following construction. steps: a. Determination that.theproper elevation of the exeatration has been reached. A Inspeetion ofthebsand and stone to be used. c. Final inspection by Board ofHedth staff or consultant. d. Installation., of tank, D -Box pipes, stone, vent, pump chambet, tetainbW waif and other components. 6. As the installer, I uriderstand that I:am solely responsible for the installation.of the.system as per the me Qr uus oDnganon. Undersigned licensed Septic Installer. Date)_ :? a -3-- f � TOWN OF NORTH ANDOVER , aonrk Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT V ; 4 t 4 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 " 0.1—W ""��.1 NORTH ANDOVER, MASSACI-iUSErrs 01845 &'�s'.CHU� �`% 978.688.9540 — Phone Susan V. Sawyer, RG.HS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdept a.townofnoriliandovea•.com W:EBSITF: http://w%vw.townofnorthandovei-.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: `l a&87I C d 1 w1/LAA&,--- Engineer: I -t tuOY (,!(G- New Plans? Yes-z$225/Plan Check #_ (includes l" submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes -Z No Local Upgrade Form Include0k)4 Yes No' TOWN OPNORT nNPOVeO, H12ALTH Dl'PA FNT Telephone #��y t; 519� Fax #- --/ggo Homeowner Name: OFFICE USE ONLY When the sub mis ' n is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database 0 M to a O20 cp U c) F4 C a� ht r + Q N � N J O c o c 0 El E CL, C3 W �. z H � a a. C a� m N � N J O c o c 0 El E to W V� C C 0 H � a a. Qz idQ c L. Uo Q OL i V) a ro 2 ❑ N LU � Z 0 ❑ I �- N M 4) E m z c D OL ro a� m N z N O c o c 0 El M to a � � a ❑ N LU � Z 0 ❑ I �- N M 4) E m z c D OL ro 0 R z z El M z O c N N � (q } C C ® ❑ Bo CDm OL � 0 a a c 0 Z 0 0 U � � - L L Lm l0 (0 c 2 o t9 C 0 ti O > 0 Q O c N Q v ui 0 R D CL •U) w0 W d V) 4) V; 'C O L- 0 0 W N N N a f� = Z � U)>_ 2 c (/f tea_ r V 'o Z 30 c E O E V U LL a 0 to 0 L6 00 ._ E Z N o ElL L N 375 m N •—> c a 0 c W : Z C ro y C O CL d o o 0 w Zs O 4) j C �O V r N N �I I42 Z O ElL L N m c a 0 C (Y. 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M t O m � c UO o nM Q. w U c 'a @ c Lc c c O a w .0 Z0 — U) O Q N D 41 d O L E d N � a r MaU) q•• Q - O '— O Z 3 0 r o 3r 0 E L U U LLL IP DelleChiaie, Pamela From: Isaac Rowe [irowe@millriverconsulting.com] Sent: Friday, January 13, 2012 11:34 AM To: Sawyer, Susan; 'Randy Burley' Cc: 'Dan Ottenheimer'; DelleChiaie, Pamela; 'Marianne Peters' Subject: RE: Plan Review - 332 Raleigh Tavern Lane - Coming in the mail. Attachments: 332 Raleigh Tavern Lane - Disapproval Letter 1-13-12.doc Susan, Attached is the disapproval letter for the above referenced property. The majority of the wall is over 4' and at the highest appears to be 5'. It is possible to use a 3:1 slope but it does get closer to the BVW. The profile shows the wall straight up but this generally is not possible unless the boulders are very large. I have asked for a detail of the wall and to clarify if the design engineer is also certifying the design of the wall. If this was my project, I would probably propose grade out the final cover with 3:1 slope or propose a 1:1 sloped boulder wall. This would provide a 5' base at the highest wall and more stability. Let me know if you have any questions. Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street North Andover Health Department (ommunity Development Division January 13, 2012 Vladimir Nemchenok c/o: Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 332 Raleigh Tavern Lane, May 107A, Lot 130 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated December 21, 2011 and received on January 4, 2012 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. It is unclear where the high ground water elevation is due to the amount of ledge in the area of the proposed septic tank. Please determine the ESHWT elevation in the proposed tank location and provide buoyancy calculations if required (3 10 CMR 15.221(8)). 2. Please submit the percolation test results on the required DEP form (NA 2.3). 3. A detail of the proposed boulder retaining wall should be provided since the height is over 4 feet. The top of the wall is at 88.5' and there is an existing spot grade of 83.5 at the bases of the proposed wall. The wall should be designed a professional engineer in accordance with 310 CMR 15.255(2)(f) and DEP guidance policy "Guidelines for Design and Installation of Impervious Barriers and Slope Stabilization for Title 5 Systems". It is unclear whether the design engineer is also certifying the design of the boulder retaining wall. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 compliance with all regulations and assure protection of public health and the environment of North Andover. usan Y. 7thD H: S Public Hector cc:David Anderson File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Q Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe@millriverconsulting.com www.millriverconsulting.com From: Sawyer, Susan [mailto:ssawyer@townofnorthandover.com] Sent: Friday, January 13, 2012 10:09 AM To: 'Randy Burley'; 'Isaac Rowe' Cc: 'Dan Ottenheimer' Subject: FW: Plan Review - 332 Raleigh Tavern Lane - Coming in the mail...... Hi, Just a comment or two about this site and our concom according to reliable sources. Our NA Conservation looked at this Wed. night. They asked Bill D. why no test pits were done on the left side and why can't he put the field there. His argument seemed thin to them. This board is really beginning to try to manage the proposals, for the purpose of getting them out of the 100 feet. Even tanks. If you have some argument to their interference, please let me know. If you are doing test pits, you may want to give the engineers a heads up if there are wetlands involved. The con com board members seem to want proof, not just professional judgment by the engineers. Also, if you are doing the review, according to their agent, the Con Com questioned if the BOH would like that boulder wall. They also think the wall needs a design because its too high. Bill says it is only 3 % feet. Whomever reviews, pis take a look at it? Thx Susan From: DelleChiaie, Pamela Sent: Thursday, January 12, 2012 3:26 PM To: 'Marianne Peters' Cc: Sawyer, Susan Subject: RE: Plan Review - 332 Raleigh Tavern Lane - Coming in the mail...... Okay, thank you. @ Best Regards, PameCa DefCeChiaie From: Marianne Peters jmailto:mpeters@millriverconsulting.com1 Sent: Thursday, January 12, 2012 2:51 PM To: DelleChiaie, Pamela Subject: RE: Plan Review - 332 Raleigh Tavern Lane - Coming in the mail...... It came today. Yes, it's stamped Jan 411, not sure why it took so long to get here; I'll save the envelope and ask the mailman why there are two barcode stickers over it. Looks like it went through some process twice....? From: DelleChiaie, Pamela ImaiIto: pdellech@townofnorthandover.com] Sent: Wednesday, January 11, 2012 8:44 AM 0 To: 'Marianne Peters' Subject: RE: Plan Review - 332 Raleigh Tavern Lane - Coming in the mail...... Oh my gosh .... you still have not received this yet??? Best Regards, PameCa DeCfeChiaie Departmental Assistant I Community Development Division I Health Department Town of North Andover -1600 Osgood Street I Bldg 20 1 Suite 2-36 1 North Andover, MA 01845 n Office - 978-688-9540 11 Fax - 978-688-8476 1 Website-hftp://www.townofnofthandover.com/Pages/index If you are happy with the customer service you have received from town departments, please let us know ... feel free to complete the general Comment Form (click on underlined link): http://www.townofnorthandover.com/Pages/NAndoverMA WebDocs/contact " I know in my heart that man is good. That what is right will always eventually triumph. And there is purpose and worth to each and every life." - Ronald Reagan - 40th President of the United States (1981- 1989) From: Marianne Peters [mailto:mpeters(a)millriverconsulting.com] Sent: Wednesday, January 11, 2012 8:26 AM To: DelleChiaie, Pamela Subject: RE: Plan Review - 332 Raleigh Tavern Lane - Coming in the mail...... Will do! From: DelleChiaie, Pamela [mailto:pdellechCabtownofnorthandover.com] Sent: Wednesday, January 04, 2012 2:17 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Subject: Plan Review - 332 Raleigh Tavern Lane - Coming in the mail...... Hello, Just a heads up ..... this was received and mailed out to you today. Please let me know when you receive it. Thank you. O Vcat Rega%4, Pamela DelleChiaie Departmental Assistant lCommunity Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 9 Office - 978-688-9540 M Fax - 978-688-8476 '1L Website http://www.townofnorthandover.com/Pages/index "I know in my heart that man is good. That what is right will always eventually triumph. And there's purpose and worth to each and every life." Ronald Reagan - 40th President of the United States (1981-1989) If you are happy with the customer service you have received from town departments, please let us know... feelfree to complete the general Comment Form (click on underlined link): http://www.townofnorthandover.com/Pages/NAndoverMA WebDocs/contact MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET • ANDOVER, MA 01810 • (978)475-3555,373-5721 • FAX (978) 475-1448 • E-MAIL!nfo@merrimackengineering.com January 24, 2012 Susan Sawyer Public Health Director 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 RE: 332 Raleigh Tavern Lane Dear Ms. Sawyer, 401 µ av TOWIq OF NORTH ANDOVER HEALTH DEPARTM5NT We are in receipt of your review letter dated January 13, 2012 for the above referenced site. With regard to item 41 of your letter, there is no soil test data in the vicinity of the proposed tank nor does Title 5 or the NA B.O.H. Regulations require testing to be performed in the area of the proposed tank. The proposed tank is in close proximity to the existing tank which has never had a history of floating so it is unclear as to why in this case, the reviewer questions this. It is unreasonable to request the owner to go through the expense of performing additional testing when we all know that if a pre -cast concrete septic tank is installed per Title 5 and with the required amount of cover it will never float regardless of the water table. Septic tanks are constructed with a wall thickness to create enough weight to prevent it from ever floating. With regard to item #2, enclosed is a copy of the percolation test results on the approved state forms. With regard to item #3, the plan has been revised to address this concern. Please note that we are not proposing a vertical wall but a slope retained with natural stones and boulders from site. On behalf of the owner, we feel we have adequately addressed your concerns and respectfully request that the plan be approved as re -submitted. Yours truly, '4_� William Dufresne Q_64/� Merrimack Engineering North Andover Health Department Community Development Division February 29, 2012 David Anderson 332 Raleigh Tavern Lane North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 332 Raleigh Tavern Lane, Map 107A, lot 130, North Andover, Massachusetts Dear Mr. Anderson, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated December 21, 2011, last revised January 23, 2012. The design has been approved for use in the construction of a replacement, four bedroom (maximum 9 -room home), onsite septic system. This plan is generally good for 3 -years from the date of approval, however since this is a repair of a failed Title V inspection, the system must be installed within 2 years from the date of the recorded failure; December 3, 2011. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. The following request was approved at the Board of Health meeting held on February 28, 2012. To allow a reduction from the leach field to a wetland from 100 feet, as required by the local NA Regulation, to 70 feet. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone:. 978.688.9540 Fax:. 978.688.8476 332 Raleigh Tavern Lane February 29, 2012 This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincere , usan Y. Sawyer, REH S Public Health Director cc: Vladimir Nemchenok, PE file Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 `delleChiaie, Pamela From: Isaac Rowe [irowe@millriverconsulting.com] Sent: Wednesday, April 18, 2012 5:01 PM To: DelleChiaie, Pamela; 'Daniel Ottenheimer'; 'Peters, Marianne'; 'Randy Burley' Cc: Sawyer, Susan Subject: RE: 332 Raleigh Tavern Lane - Final Construction Inspection Request Attachments: 332 Raleigh Tavern Lane - Construction Inspection 4-18-12.doc Susan, Attached is the inspection report for the above referenced property. As you probably already know, Todd is going to insLaiL rhe rank on his wav out of the property. He had to build an access road for the SAS construction. Will you do the inspection on the tank and connection to the d -box? If so, you will need to make sure the inlet/outlets of D -box are hydraulic cemented and inlet tee is installed. Todd said since D -box has rubber gaskets no hydraulic cement is required but I told him to call you directly for final approval. If you want us to do the tank inspection let us know. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe@millriverconsultiniz.com www.millriverconsulting.com -----Original Message ----- From: DelleChiaie, Pamela[mailto:pdellech@townofnorthandover.com� Sent: Wednesday, April 18, 2012 9:19 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burfey' Cc: Sawyer, Susan Subject: FW: 332 Raleigh Tavern Lane - Final Construction Inspection Request Good morning! Please schedule a final construction inspection for 332 Raleigh Tavern Lane with Todd Bateson. His number: 978-815- 2703. Thank you!:) Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg. 20 1 Suite 2-36 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com DelleChiaie, Pamela From: wrdufresne@comcast.net Sent: Tuesday, January 31, 2012 10:48 AM To: De "e, Pamela Subject: e: 332 R leigh Tavern Lane Pam On behalf of our client, Dave Anderson, owner of 332 Raleigh Tavern Lane, we hereby request that we be placed on the next available meeting agenda for discussion of a variance from the North Andover Board of Health Regulations to allow a proposed leach field to be 70 feet from a wetland where 100 feet is required by the Board of Health Regulations. Plans depicting this request have been submitted to the Board of Health. Thank you, Bill Dufresne Merrimack Engineering From: "Pamela DelleChiaie" <pdellech townofnorthandover.com> To: "wrdufresne(a)-comcast.net" <wrdufresne _comcast.net> Sent: Monday, January 30, 2012 2:18:35 PM Subject: RE: 332 Raleigh Tavern Lane - Need Request for Local Variance A detailed email is fine. Thank you. - Best Regards, Pamela DelleChfaie Departmental Assistant I Community Development Division I Health Department Town of North Andover -1600 Osgood Street I Bldg 201 Suite 2-361 North Andover, MA 01845 9 Office - 978-688-9540 12 Fax - 978-688-8476 1 Website-htto://www.townofnorthandover.com/Pages/index From: wrdufresneacomcast.net[mailto:wrdufresneCabcomcast.netl Sent: Monday, January 30, 2012 1:32 PM To: DelleChiaie, Pamela Subject: Re: 332 Raleigh Tavern Lane - Need Request for Local Variance Pam Can I do it via e-mail or do I need to mail a letter, please advise. From: "Pamela DelleChiaie" <pdellech _townofnorthandover.com> To: "Bill Dufresne (wrdufresneaa.comcast.net)" <wrd ufres nea- com cast. net> Cc: "Susan Sawyer" <ssawyer _townofnorthandover.com> Grant, Michele From: Sawyer, Susan Sent: Thursday, April 12, 2012 12:57 PM To: Grant, Michele; DelleChiaie, Pamela Subject: 332 RTL Bill Dufresne called, He was at 332 Raleigh Tavern Lane. The plan had an error on the house which resulted in 4 feet less to the field. There was a jog in the house he missed. The new distance is 30 feet from the corner. I am sure they will be calling for a Bottom of Bed soon. Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg. 20, Unit 2-36 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email ssawver@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: h_p://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. TOWN OF NORTH ANDOVER „ORTa 1 Office of COMMUNITY DEVELOPMENT AND SERVICES D "o HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 } "•• ,r NORTHAND USE_TTS 01845 7f Susan Y. Sawyer, REAS, RS 978 88.9540 - Phone X5 Public Health Director R 97 688.8476 - FAX rm) ECj� +� i he hde t townofnorthandover.com � y�o�jP wnofnorthandover.com TOWN OF NORTH AN VER,' �1 HEALTH DEPARTMENT APPLICATION FOR SOIL DATE: � �j (� MAP & PARCEL: 10-IA 13 LOCATION OF SOIL TESTS: OWNER: Contact#: %0' i1 � �c h�1�Ly��?2� Z— � � �I APPLICANT: '*7A "i� Contact #: ADDRESS: ENGINEER: L4t'ri c�.ip l�-[ uCr Contact #: ��/ 7� Q_175, - 35; 5 7 CERTIFIED SOIL EVALUATOR: 1371 jL ��1! (� ��%� � 570 `7/ Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing Upgrade for Addition: In the Lake Cochichewick Watershed? Yes C� No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5" x 11 "Plot plan & Location of Testing (please indicate test nit sites on the plan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Feb of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Datei' Signature of Conservation Agent: e -b --S-t4lz Y, t � Date back to Health Department. (stamp in): ' j.+s.-+em'+rtw..,-,.r-�-:......,.-Y-�:.n�^�:.....r<.art.AR•u.��.,M'•'a�r�..--"'�":T =.eSMA'aM'aTgea'waR+v+�xv'...p^Baa.rer�M"CAk.R"�Mt'�!/.K:»MI.T:i3�"��'+®F'J;�'zYtNe.^eves*'"wF'+1' r ,w•r<..r. --r>r...-... L7 O N9, SLuCIJ I N 08 C1 vw U_ _ Es O d0.1 x4 h << 1 3- GI o &— cs n .n ca = v 0 z M: U- C y < Etj x m -j cr w0 x(d3k��" zcoLu �LLI OC I ` NO fi ro CO ON fr) C^� Ih U) ED trjI/ N, . co N O �O. -- "-..wr�.w.v.,...a�..-r csn.sc.--�:f ^rY•�.-�.,, mrem�mjjpl c F _ < �'- a W e> N C+ L= * I R N -s Z l Ab 0 co C C 4` 4 It, } Q Ld U) Q J N U) aco O << Ld t� _ja_ LL c� LLJ -jLd c I:a ) s! cr s.1 cn C> trjI/ N, . Ld r X U w -d (7 i�•14 (ij' fl�;lJ x Cn W Ls1 i LLI It 1t _j rc 11% DelleChiaie, Pamela From: Isaac Rowe [irowe@miliriverconsulting.com] Sent: Thursday, December 15, 2011 8:35 AM To: 'Susan Sawyer(ssawyer@townofnorthandover.com)' Cc: DelleChiaie, Pamela; 'Dan Ottenheimer'; 'Marianne Peters'; rburley@millriverconsulting.com; irowe@millriverconsulting.com Subject: Soil Test Results - 332 Raleigh Tavern Rd & 730 Winter St Attachments: 332 Raleigh Tavern Road - Soil Test Results 12-13-11.pdf; 730 Winter Street - Soil Test Results 12-14-11.pdf Susan, Attached are the soil logs for the above referenced properties. Atlantic Eng was very professional and a pleasure to work with. Please let me know if you have any questions. I also dropped off that soil sample for Cricket Lane. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe(cDmillriverconsulting.com www.miliriverconsulting.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/l)reidx.htm. Please consider the environment before printing this email. N 't4vi I on Important: When filling out forms on the computer, use only the tab key to move your cursor - do hot use the return key. "Q ISI Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. A. Site Information Dave Anderson Owner Name 332 Raleigh Tavern Lane Street Address or Lot # North Andover City/Town Contact Person (if different from Owner) B. Test Results Observation Hole # Depth of Perc Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate (Min./Inch) MA 01845 State Zip Code (978) 973-3555 Telephone Number 12-13-11 11:30 Date Time P-1 68" 11:30 11:45 11:45 12:26 1:15 49 17 Date Time Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Bill Dufresne / Merrimack Engineering Test Performed By: Isaac Rowe / Mill River Consulting Witnessed By: Comments: t5form12.doc• 06/03 Perc Test - Page 1 of 1 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 332 Raleigh Tavern Lane Property Address David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. RECEIVED Important: A. General Information When filling out DEC qq forms on the D " 8 G 0 11 computer, use 1. Inspector: only the tab key TOWN OF NORTH ANDOVER to move your Neil James Bateson HEALTH DEPARTMENT cursor - dopot Name of Inspector use the return key. Bateson Enterprises Inc. Company Name VQ 111 Argilla Road A 10 Company Address Andover MA 01810 Cityrrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 12/3/2011 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 R _im Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavem Lane Property Address David Anderson Owner's Name North Andover Cityrrown B. Certification (cont.) MA 01845 12/3/2011 State Zip Code Date of Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ one or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y 0 N ❑ ND (Explain below): t5ins • 11/10 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. t5ins • 11110 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavern Lane Property Address David Anderson Owner's Name North Andover MA 01845 12/3/2011 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Title 5 Official Inspection Fonn: Subsurface Sewage Disposal System • Page 3 of 17 MIN Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavem Lane Property Address David Anderson Owner's Name North Andover City/rown B. Certification (cont.) MA 01845 State Zip Code 12/3/2011 Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ N Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5ins -11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes Commonwealth of Massachusetts d Title 5 Official Inspection Form the system is within 400 feet of a surface drinking water supply Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '< 332 Raleigh Tavern Lane ❑ Property Address the system is located in a nitrogen sensitive area (Interim Wellhead Protection David Anderson Area — IWPA) or a mapped Zone II of a public water supply well Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '< 332 Raleigh Tavern Lane Property Address David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): N/A Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): N/A t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Commonwealth of Massachusetts ❑ No ❑ Title 5 Official Inspection Form ❑ No ❑ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ❑ No 332 Raleigh Tavern Lane Property Address David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ®' No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 9 ( Y 9 (gp ))� Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 332 Raleigh Tavem Lane Property Address David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. Citylrown State Zip Code Date of Inspection E D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: Date General Information Pumped 2010, owner Was system pumped as part of the inspection? If yes, volume pumped: 1000 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank & tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ® Yes ❑ No ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 332 Raleigh Tavern Lane Property Address David Anderson Owner information is required for every page. E t5ins • 11110 Owner's Name North Andover City town D. System Information (cont.) State Zip Code 12/3/2011 Date of Inspection Approximate age of all components, date installed (if known) and source of information: Tank original, installed 10/28/1973. Outlet pipe, d -box & field 23 years old, 4/29/1988, as built plans Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" cast thru wall 3" PVC in house. No leaks visible. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 1 feet ❑ Yes ® No ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: . years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: Tx 5'x 4' Sludge depth: ❑ Yes ❑ No 1" Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavem Lane Property Address David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 - - - every page. H I1.17MIUfr1 Cityfrown D. System Information (cont.) State Zip Code Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Date of Inspection Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 20" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet baffle ok. Outlet tee ok. Depth of liquid above outlet invert. no evidence of leakage. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: feet ❑ polyethylene ❑ other (explain): Date Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 .�L\ • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "< 332 Raleigh Tavern Lane Property Address David Anderson Owner • Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. E Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes, ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavern Lane Property Address ° David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 4 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Liquid level in d -box above outlet inverts. No evidence of leakage. Evidence of solid carryover. Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: ❑ Yes ❑ No ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavern Lane Property Address David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field 18'x 38' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Owner information is required for every page. E t5ins • 11110 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavern Lane Property Address David Anderson Owner's Name North Andover MA 01845 12/3/2011 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavern Lane Property Address David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately 2 0 N a= 1g' 6o'ro rr t5ins • 11/10 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 15 of 17 0 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 332 Raleigh Tavern Lane Property Address David Anderson Owner Owner's Name information is required for North Andover MA 01845 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water. 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan revi&rved: 10/28/1973 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Old design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: No water found on old design plan. New field was installed at the same location & elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 332 Raleigh Tavern Lane Property Address David Anderson Owner information is required for every page. Owner's Name North Andover MA 01845 12/3/2011 Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins -11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 c j. Commonwealth of Massachusetts = City/Town of T System Pumping Record yForm 4 DEP has provided this form for use by local Boards of Health. Other forms'may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: I-< Right front of house Left / Right rear of house, Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address '=-� 0,,,4.j aA-(-N A-,-< Citylrown State Zip Code 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): stat e.� � p ode Telephone Number (—TL ta&-3--k( Date 2• Quantity Pumped: Cesspool(s) eptic Tank l�� Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes Ei-No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Syste t 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati a contents were disposed: G. S. _ Lowell Waste Water iulel Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 L!�.L.l:** THIS PLAN & CERTIFICATION 1S NOT A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. IT IS A RECORD OF THE LOCATION AND ELEVATION OF THE EXISTING SYSTEM COMPONENTS. "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS -BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. 1Viy►cua/ �kaafk-lf2 o 3'- ©� 1 Z., SIGNATURE OF DESIGNER DATE AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM = o LOCATED IN Z , NORTH ANDOVER, MASS. /332 RALEIGH TAVERN LANE o a �y rn o A` 4 AS PREPARED FOR D DAVID ANDERSON TM: IOTA Z�ft3 N DATE: 5„04-12 TL: 130 m SCALE: I"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 86 PARK STREET ANDOVER, MASSACHUSETTS 01610 a H E L'oT 42 r Lor 43 //� 1 3 2 s ;, F, - - � 1 viLV' Af. N - 1`13 38 (_ D. -Box Tf OAK oAtt RALE f GH TAVERN LAME BATESON ENTERPRISES, INC. ill ARGILANDOVER, MA 01810 PLANT SHD,-/�r,G NEIR,I SUBSC-nF/�c SEWAGE P15P0-S"iL SYSTE; 1 LOCATION'332- %CALF/SH TAV1_-=RA1 LN, IVOR7"N ANDOVER MA. OWNER: MR, DAVID ANDERSJN DAT E : A P) l L 29, /738 til i 10 Scab